Healthcare Provider Details

I. General information

NPI: 1962766444
Provider Name (Legal Business Name): DENISE A FLANAGAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 355
INDIANAPOLIS IN
46260-1987
US

IV. Provider business mailing address

8240 NAAB RD STE 355
INDIANAPOLIS IN
46260-1987
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-1095
  • Fax: 317-875-7275
Mailing address:
  • Phone: 317-876-1095
  • Fax: 317-875-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009664A
License Number StateIN

VIII. Authorized Official

Name: DR. DENISE A FLANAGAN
Title or Position: OWNER
Credential: DDS
Phone: 317-876-1095